When you’ve been an endodontist for 15 years like me, you develop a ‘greatest hits’ of things you’ve learned over the years. My top endo tips and tricks have truly helped me become more effective, efficient, and profitable.
Now, I don’t have all the answers, because I’m always learning, just like anyone else! But I have dedicated my life to fine-tuning my insights, processes, and techniques for saving teeth… and saving you time! And I know that hundreds of E-School students have used these techniques to save more teeth, too. The impact is really amazing.
So, I wanted to compile a “cheat sheet” of my top endo tips and tricks in this blog post. I can’t compress everything into a single place—that’s what E-School is for!—but I want to share some of my favorites. So, here are several outcome-boosting, time-saving endo hacks I’ve developed, curated by yours truly.
My Top Endo Tips & Trick for Diagnosis
Diagnosis is your bread and butter when it comes to endodontics. I always say, “If you are finding and treating pain, you are doing endo!”
So, let’s make diagnosis simpler, so you can set yourself up for better outcomes.
Before you access or even a treatment plan, you need to know what’s going on with that tooth. That’s why getting the right endodontic diagnosis is so critical.
It might feel basic and boring, but I prefer to think of it like being a detective. What happened here? What kind of diagnosis am I looking at? What will I do next?
Don’t skip this step! I’ve created a blog post to help you get the right pulpal and periapical diagnosis, every time. Check it out!
Let’s Talk Pain Management & Antibiotics
Pain medication and antibiotics are part of any dentist’s pharmaceutical toolkit. But we don’t always want to use them with every patient and in every situation. In fact, I ask patients to come to my endodontic practice without pain meds or antibiotics in their system, since these medications can mask what the patient is feeling and experiencing, making diagnosis harder. So what’s a dentist to do, if you want to make your patients comfortable?
I also want to draw the distinction that antibiotics are not pain relievers! Yes, they can help with infections, but they can also mask symptoms and lead to antibiotic resistance. Some patients even have allergies to antibiotics.
One of my quick tips is to supplement antibiotics with probiotics. Read more in this blog post.
My Top Endo Tip for Occlusal Reduction
Occlusal reduction is super useful for creating a repeatable surface as your reference point for a consistent working length. Plus, it helps to minimize postoperative pain. So right after making your patient numb, reduce the cusp tips to create that flat platform for your work.
I personally do the reduction prior to placing the rubber dam because every time I don’t, I catch the dam with my bur and then have to start over. Frustrating!! But when you do it in the order I recommend, you won’t run into this issue, while also allowing your patient’s tooth a better chance to heal without interference.
Plus, it’s just straight-up easier. You are more likely to remain consistent and steady through the procedure, and your obturation will be more accurate. Read more about this tip here.
My Top Endo Tips & Tricks for Rubber Dams
Before you jump straight to punching a hole in the center of that rubber dam, consider this: if you punch it in the middle, that thing is gonna be right over the uvula, and it’s going to cause a whole bunch of unpleasant experiences for you and your patient. And that sucks, because it’s super avoidable.
Before you punch a hole in the rubber dam, make sure things make sense. Figure out what tooth number you’re treating and notice how most teeth are offset from the middle. If you punch a hole in the middle unnecessarily, all you’ve done is made a rubber dam that feels like it’s in the way, and that can lead to costly mistakes.
(Psst. By the way, it’s super easy to get around this with my free rubber dam template!)
An “Un-Tip” for Endodontic Access
Access sounds easy, but a lot of dentists can really struggle with it, without realizing they are struggling. I can see the evidence of this when patients get referred to my endodontic practice, so let’s all approach this quick tip with the humble assumption that we all have something to learn. After all, if your access is off, instrumentation and the rest of the procedure will be harder.
I often hear this tip being shared: “Wait for the handpiece to ‘drop’ to let you know you’re in the chamber as you access.”
Please don’t do this any more! This is a reverse-tip. An “un-tip”!
I don’t like this “drop-in” method, unless you’re paying hyper-close attention to your radiographs (and even then, it makes me nervous).
Create an Instrumentation Workflow for Better Outcomes
Every single tooth is different. Every. Single. One. And that means that instrumentation can vary wildly from tooth to tooth.
So, my strategy has been to create a workflow that provides structure and a system to my instrumentation approach, while also allowing for flexibility within your procedure. It minimizes mistakes and improves efficiency.
When you follow a repeatable system, you can increase your consistency, efficiency, and ease. Because the last thing you want to feel during a root canal is anxiety.
That’s why I’m sharing with you my baseline protocol that you can put into practice today and use for every single root canal. You can download the Instrumentation Workflow here.
Here’s a bonus tip: When it comes to file lengths, here’s my quicksheet: When the tooth working length is…
- 22mm or shorter ➡️ Rotary file: 21mm
- 23-26mm ➡️ Rotary file: 25mm
- 27mm or longer ➡️Rotary file: 31mm
My Top Endo Tip for Obturation and Gutta Percha
Retreatments are unavoidable in endodontics. Sometimes a canal gets missed, despite your best efforts. Sometimes new decay has exposed the tooth’s root canal, and bacteria has gotten back in. You can be the best endodontist in the world, and you’ll still have to retreat a tooth here or there.
And that means you’re going to have to get comfortable with removing gutta percha. In this post, I give you a few tips for removing the old gutta percha so you can complete treatment.
There’s More Where That Came From
There is no way I can share everything I learned over the course of my career without talking your ear off for literally hours. These were just some nifty tips I thought could help you out right here, right now, today.
But if we’re thinking about tomorrow, then I want to encourage you to enroll in E-School, my award-winning endodontic CE curriculum that reveals all of my endodontic knowledge with detailed modules and downloads.
Enroll in E-School now! Knowledge is power. Let’s be empowered together.
– Sonia